Antidepressants during pregnancy and the potential for harm to the baby + a little on how complex it is to find good information online

This post comes from something I saw on Facebook. People were worried about the effects of psychotropic medication when used in pregnancy.

There's a bizarre finding that SSRIs that have washed into the water supply are affecting shrimp. The shrimp were found to be going to shallow waters where they'd be eaten quicker. The amount of SSRI must have been tiny which is what surprised me about the result but it made me think of the possibility that there may be an effect on the foetus.

Of course psychiatrists have thought about this too. I did a search on pregnancy and SSRI. I didn't use Google Scholar because I wanted to get this done quick rather than reading through the studies and finding the truth for myself. It's worth doing as I found in my research on clozapine.

The first link points to little to no serious risk to the foetus though there may be problems with withdrawal if antidepressants are used late in the pregnancy. According to this review there is no risk of malformed babies. The behavioural risks are far greater.
http://priory.com/psych/adspregnancy.htm

The second link is to a BMJ article fromn 2006 which says there may be a risk of malformed babies.
http://www.bmj.com/content/333/7573/824.5.full
"
“Our data indicate a moderately increased risk of congenital malformations associated with prenatal exposure to SSRIs,” write the authors, from Aarhus University Hospital in Denmark. “Further studies are needed to confirm this risk and to clarify whether the risk is attributable to the drugs themselves, to underlying psychiatric disease, or to other confounding factors.”
"

The third link says there's no risk and has lots of information. It was published in 1995. It categorically states there's no risk from paroxentine.
http://www.antidepressantsfacts.com/review-pregnancy-ssri.htm

The fourth link is from the BBC and was put online in 2009. It cites information from the Danish study but it also has new information.
http://news.bbc.co.uk/2/hi/health/8273350.stm
"
In 2005, the US Food and Drug Administration issued a warning about the SSRI paroxetine because of an increase in birth defects if it was taken during pregnancy.
"

The fifth links has some useful analysis on the problem of working out if it's the SSRI or depression that causes the small increases in birth defects. It also subtly makes the point that a lot of the research is funded by pharmaceutical companies.
http://psychiatry.jwatch.org/cgi/content/full/2007/627/1

The Mayo Clinic is one of the best sites for health information. It's the sixth link so I've bothered to check it out. A doctor would probably choose to looked at the priory.com link, the BMJ link or the Mayo Clinic one. It's my personal favourite and shows how doctors attempt to weigh the pros and cons. Sadly they may not always get it right. There is a risk with some antidepressants which is well established and risks with others that aren't well established or replicated and in the absence of confirmation it seems the SSRIs and tricyclics will continue to be used.
http://www.mayoclinic.com/health/antidepressants/DN00007

Their conclusion is a good summary.
"
If you have depression and are pregnant or thinking about getting pregnant, consult your health care provider. Sometimes mild depression can be managed with psychotherapy, including counseling or other therapies. If your depression is severe or you have a recent history of depression, the risk of relapse may be greater than the risks associated with antidepressants.

Deciding how to treat your depression during pregnancy won't be easy. The risks and benefits of taking medication during pregnancy must be weighed carefully on a case-by-case basis. Work with your health care provider to make an informed choice that gives you — and your baby — the best chance for long-term health.
"